Substance use outcomes among pregnant and postpartum women in methadone maintenance treatment
Pace, Christine A.
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Background: Methadone maintenance treatment (MMT) is widely used to treat opioid dependence during pregnancy. Though data suggest pregnant women are more likely to engage in MMT compared to non-pregnant women, few studies have examined the effect of pregnancy on abstinence from illicit substances. In addition, there are scant data on postpartum substance use outcomes despite the importance of the postpartum period in determining whether a woman continues in recovery long-term. Methods: Retrospective study of medical records from pregnant and non-pregnant women who emolled in an MMT program over a five year period. Multivariable generalized estimating equations (GEE) logistic regression was used to examine the effect of pregnancy status (pregnant, postpartum or non-pregnant) on the odds of giving an opiate negative urine drug test, and on the odds of giving a urine that was negative not only for opiates, but also for cocaine and benzodiazepines. Results: Urine drug tests from pregnant and postpartum women had almost three times the odds of being opiate-negative urine compared to those from non-pregnant women (AOR 2.90, 95% CI 1.94, 4.33 for pregnant vs. non-pregnant; AOR 2.78, 95% CI 1.77, 4.38 for postpartum vs. non-pregnant). Drug tests from women who were in a residential program on emollment were more likely to be opiate-negative. Results were similar for urine drug tests that were negative for opiates, cocaine and benzodiazepines. Conclusions: Pregnant women with opioid dependence reduce their use substantially in the context of a comprehensive, multidisciplinary program including MMT, and women who remain in MMT postpartum continue to do well. However, the programming needs of non-pregnant women require more attention. In particular, further research should identify whether enhanced access to residential programs or other treatment modalities could help improve this group's engagementwith recovery.
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